The association of loneliness and social isolation with healthcare utilization in Denmark

Abstract Objectives The present prospective cohort study investigated the association of loneliness and social isolation (SI) with healthcare utilization (HCU) in the general population over time. Methods Data from the 2013 Danish “How are you?’ survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and chronic disease. Results Loneliness measured at baseline was significantly associated with more GP contacts (incident-rate ratio (IRR) = 1.03, 95% confidence interval (CI) [1.02, 1.04]), more emergency treatments (IRR = 1.06, 95% CI [1.03, 1.10]), more emergency admissions (IRR = 1.06, 95% CI [1.03, 1.06]), and hospital admission days (IRR=1.05, 95% CI [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which SI was associated with fewer planned outpatient treatments (IRR = .97, 95% CI [.94, .99]). Conclusions Our findings suggest that loneliness is a risk factor for certain types of HCU, independent of social isolation, baseline demographics, and chronic disease. Key messages The findings suggest that lonely individuals are slightly overrepresented within the healthcare system. In contrast, social isolation does not affect the use of health care services. The association between loneliness and health care utilization is complex and there is a need for future studies to investigate the mechanisms underlying the association.


Background:
Following the increased internet use due to the COVID-19 pandemic there have been concerns regarding an elevated risk of developing internet addiction (IA). University students are especially prone to develop IA and risk factors for its development in this population during pandemics are not fully investigated nor understood. This study aimed to identify possible risk factors of IA in the studied population during the ongoing pandemic and to compare it with risk factors in prepandemic time.

Methods:
In April 2016 and April 2022 a validated, anonymous questionnaire that contained questions regarding demographic data, as well as Young's Internet Addiction Test, was selfadministered to a cross-faculty representative student sample of the University of Osijek, Croatia.

Results:
The study included 1602 university students median age of 21 years (interquartile range 20-22), 34.5% males, and 65.5% females. There was no statistically significant difference in the median age between the two student samples (p = 0.234). The main reason for internet use (social networking and entertainment and online gaming) was considered the significant risk factor for IA in a studied population in pre-pandemic time (the year 2016) and pandemic time (the year 2022) (p < 0.001). In pre-pandemic time the IA was more frequent in males (p = 0.046) while the difference in IA prevalence between sexes did not exist during pandemics (p = 0.160). During pandemics, the students who did not work during their study had higher proportions of IA (p = 0.021) while there was no difference in IA prevalence among students regarding their working status during the study in pre-pandemic time (p = 0.251).

Conclusions:
During the COVID-19 pandemic working status of students has been recognized as the new risk factor for IA in the Croatian university students population. Further studies are needed to identify other possible risk factors for IA in the studied population during pandemics. Key messages: The COVID-19 pandemic has changed the set of risk factors for IA among Croatian university students. Better understanding of risk factors for IA among university students during the COVID-19 pandemic will enable the development of successful preventive programs for this behavioral addiction.

Background:
Evaluation of preoperative anxiety and health literacy is important for healthcare professionals to understand the needs and expectations of patients and provide them with the necessary support. The study aimed to evaluate the preoperative anxiety levels of patients who applied to the anesthesia outpatient clinic and its relationship with health literacy.

Methods:
A cross-sectional study was conducted on patients who applied to the anesthesia outpatient clinic of Eskişehir Osmangazi University Medical Faculty Hospital in March 2022. The questionnaire form, which was prepared by making use of the literature, was filled in by face-to-face interview method after obtaining the participants' verbal consent. The 6 item Amsterdam Preoperative Anxiety and Information Scale (APAIS) in which the scores that can be taken range from 6 to 30 and higher score means higher anxiety was used to assess the level of anxiety, and the 16 item European Health Literacy Scale Short Form was used to assess health literacy. Descriptive statistics, Chi-Square test and Logistic Regression analysis were used to analyze the data.

Results:
In the study group, 197 (50.3%) were female. Their ages ranged from 18 to 86, with a mean of 45.7 AE 17.2 years. The median (min-max) APAIS score was 15 (6-30). There was a moderate negative correlation between the scores obtained from the APAIS and the European Health Literacy Scale Short Form (r = -0.50, p < 0.01). According to the logistic regression analysis, preoperative anxiety was found to be 1.53 (%95 CI; 1.01-2.30) times higher in women, 3.49 (%95 CI; 1.23-9.94) times higher in those with low family income, and 1.61 (%95 CI; 1.07-2.42) times higher in those with type A personality.

Conclusions:
More than half of the patients had preoperative anxiety. The level of preoperative anxiety decreased as the health literacy level increased.
Key messages: Necessary support should be given for the preoperative anxiety of the patients. Public health policies should be developed in order to increase health literacy.

Objectives:
The present prospective cohort study investigated the association of loneliness and social isolation (SI) with healthcare utilization (HCU) in the general population over time.

Conclusions:
Our findings suggest that loneliness is a risk factor for certain types of HCU, independent of social isolation, baseline demographics, and chronic disease.

Key messages:
The findings suggest that lonely individuals are slightly overrepresented within the healthcare system. In contrast, social isolation does not affect the use of health care services. The association between loneliness and health care utilization is complex and there is a need for future studies to investigate the mechanisms underlying the association.

Background:
The presentation is dedicated to employees who care for others in addition to their work. The starting point is the representative cohort study on mental health at work (S-MGA), which covered both care at home and care outside the home in the second wave of the survey. In this regard, cross sectional associations with exhaustion and work-life balance as indicators of mental health were examined taking into account full-time and part-time employment.

Methods:
The sampling frame consisted of all German employees being subject to social security contributions and born between 1951 and 1980. The baseline sample consisted of 4511 survey participants of whom 1279 males and 1358 females were asked for informal care at the follow-up interview. Employment conditions as well as work-life balance were obtained by personal interview; exhaustion was obtained in a paper and pencil questionnaire. Statistical analysis was conducted descriptively and in linear and logistic regressions stratified by gender and controlled for age.

Results:
Informal care at home was reported by n = 74 individuals (2.8%) and care outside of their home by n = 236 (8.9%). The association between both types of care with exhaustion was below the level for significance. There was an increase of worklife-imbalance for females caring at home but not for those who were caring outside. For males there were no effects of both types of care. Including the part-time/full-time distinction indicator within the regression models showed that women who cared at home had lower exhaustion scores and lower work-life imbalance when they were employed parttime.

Conclusions:
The results show that caring at home for females leads to worklife imbalance and that part-time employment mitigates the negative effects on work-life imbalance and exhaustion. However, there are strong limitations by the sample size and the number of observations at the second wave of assessment.

Key messages:
The results show that caring at home among females seems to lead to work-life imbalance. Part-time employment seems to mitigate the negative effects on work-life imbalance and exhaustion.

Background:
During the COVID-19 pandemic students' lives changed drastically, especially regarding their mental health. Social isolation, induced by lockdown, could be the cause of the development of mental disorders in this population. Therefore, the aim of this study was to identify factors associated with depression during French first Covid-19 lockdown among university students.

Methods:
This cross-sectional study, which is a part of the COVID-19 International Student Well-Being Study (ISWS consortium), used the validated CES-D 8 score (Center for Epidemiologic Studies -Depression Scale) to measure depression levels. Data on socio-demographics, curriculum, living condition, academic environment and social interactions were collected few days after the first lockdown in France, from 13 to 31 May 2020. The potential impact of risk factors on depression was studied by multinomial logistic regression.

Results:
A total of 3593 students were included. The CES-D 8 mean score was 8.65 (SD = 5.08). Literature students had the highest average CES-D 8 score (9.47, SD = 5.16). Independent factors associated with the higher scores of depressions included having limited financial resources (AOR = 2.49, 95% CI = 1.84-3.38) having academic concerns, including students worried about not completing the academic year (AOR = 2.93, AOR = 2.37-3.64) and stressed with changes in teaching methods (AOR = 3.55, 95% CI = 2.82-4.46). Otherwise, living with parents during lockdown and being in a relationship were significant protective factors against depression.

Conclusions:
This study highlights the impact of changing social network, living conditions, and academic environment on depression among university students. Preserving students from social isolation must be a critical priority for universities. Future universities' policy strategy could combine on-site teaching with online courses and consider the role of students' social contacts, with a particular emphasis on mental health. Key messages: Social isolation is an important risk factor of depression in students. Implications for policy makers demonstrating the need for effective mental health programs and guidance as a public health strategy in universities.